Even red states feel the brunt of Trump’s ACA sabotage campaign

Donald Trump won Iowa by nearly 10 points in the presidential election. The state has a Republican governor, two Republican U.S. senators, a Republican-led state House, and a Republican-led state Senate. It’s therefore tempting to believe whatever Iowa wants from the White House, this president is likely to say yes.

But there’s fresh evidence that Trump hates the Affordable Care Act more than he loves the Hawkeye State. The Washington Postreported late yesterday:

For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application.

Trump’s message was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.

Supporters of the Affordable Care Act see the president’s opposition even to changes sought by conservative states as part of a broader campaign by his administration to undermine the 2010 health-care law. In addition to trying to cut funding for the ACA, the Trump administration also is hampering state efforts to control premiums. In the case of Iowa, that involved a highly unusual intervention by the president himself.

Some background is probably in order. Over the course of several months, GOP officials in Iowa crafted an ambitious series of reforms to help stabilize its state insurance market, taking advantage of a provision in the ACA – known among health care wonks as Section 1332 waivers – that allows states to come up with state-specific modifications to the law.

The catch is, federal officials have to sign off on the changes. Iowa Republicans probably thought their ally in the White House would side with them, but they thought wrong.

The trouble apparently started when the Wall Street Journalreported in late August on Iowa’s changes*. It was soon after that the article crossed the president’s desk, prompting Trump to personally direct HHS to reject the Hawkeye State’s proposed reforms.

What’s more, Iowa’s not alone. State officials in Oklahoma – one of the nation’s reddest red states, which Trump won by 36 points – spent months on a market stabilization plan of their own. The state submitted its waiver request on time, but the Trump administration didn’t respond until after the deadline had passed.

Oklahoma’s top health official responded with a rather angry letter to Trump administration officials, explaining, among other things, that their failure to act will cause consumers in the Sooner State to pay higher premiums.

The Post’s article, meanwhile, noted that Minnesota had a related plan for its state system, which had bipartisan support from state officials, but which the Trump administration handled in the worst possible way: HHS said Minnesota could pursue its reforms if the state accepted millions of dollars in cuts to federal health care spending.